Thousands of keratoconus patients each year are advised by their eye doctors to get corneal transplant surgery (keratoplasty). The great majority of this patient population in reality would do quite well with properly fitted scleral lenses. Keratoplasty is not a “walk in the park.” There are real risks associated with this procedure. The following are the facts associated with keratoplasty:
1. Over 50% of those patients receiving corneal transplant surgery with need scleral lenses in order to achieve visual acuity greater than 20/50. Contrary to what one might think, these lenses are comfortable and very easy to wear.
2. It will take about 1 year for vision to stabilize.
3. There may be a limited lifespan to the transplanted cornea. Repeated corneal transplant surgery due to rejection and/or infection is the 2nd commonest indication for keratoplasty.
4. There is a risk of life-long rejection (this decreases after the first year).
5. There is a susceptibility to traumatic wound rupture.
6. During the first year after the corneal transplant surgery, anti-rejection eye drops will need to be used. The used of these eye drops may increase the risk of glaucoma and cataracts.
For the above reasons, I always recommend that patients with keratoconus and other corneal conditions consider every non-surgical alternative before getting involved with corneal transplant surgery.
A well designed and fit scleral lens serves 3 functions: A. Protect the compromised cornea from the environment and the blinking action of the eyelids. B. Keep the eye moist as most keratoconic corneas have a dry ocular surface. C. Provide excellent vision along with excellent comfort.
The photo below shows a transplanted cornea with sutures. Do you want to do this to your eye?
These photos are of two eyes that underwent corneal transplant surgery that resulted in corneal rejection followed by infection inside the eye( endophthalmitis ) Sadly the result was permanent blindness. While these events are rare they do occur.